Name of Student _______________________________________________________Age ________Sex_______
Address ___________________________________________________City _________________Zip__________
Home Phone _____________________________________Birthday ___________________________
Mother’s Name ________________________________________Cell ___________________________
Father’s Name________________________________________ Cell___________________________
Amount paid ________________ Email ___________________________________________________

List Classes for Enrollment

Medical information:_____________________________________________________________

 ____________________________________________________________________________

Would you like to have your account automatically charged?  Yes____ No _____ 

Would you like costumes and recital fees also deducted on the due date? Yes _____No ________

_______Master Card   ________Visa     ($5 Charge for American Express)

 Credit/Debit Card _____________________________ expiration Date_______ 

Credit Card Policy: Due to past problems with overdue accounts, we are forced to require the additional security of a major credit card for each student’s account.  This will only be used for those accounts that are overdue or for those that sign up for automatic billing. By signing below you are agreeing to the following:

   1. Any tuition that is not paid for by the 10th of the month, in which it is due, will be billed to your credit card along with a $15 late fee.

Name of Parent ___________________________________________  (please print)

Signature of Parent __________________________________  Date____________

Axis Dance Center Policy

Please read the following studio policies and initial and sign where indicated:

Please go over the policies with your child/children so that they understand the rules of Axis Dance.  If any portion of the studio policy form is not filled out and initialed it will be sent back for you to complete.  A new registration and policy form will need to be filled out at the beginning of each new year, for each family. 

Registration and Tuition Policy: We will charge a non-refundable registration fee of $25 per student or $50 per family per year.  Tuition is due the first day of each month.  If payments are not in our office on or before the 10th of each month a $15 late fee will be applied to your account.  If tuition has not been paid by the 15th of the month, your tuition and late fee will automatically be charged to your credit card.  There will be a $25 returned check fee (NSF) charged to your account on all returned checks.  Tuition is the same amount each month, 3, 4, or 5 week months are all considered a full calendar month. Dress rehearsals and extra practices that are scheduled for competition classes might have extra fees of $10 per student. You will be informed of these ahead of time. __________ 

Adding and Dropping Classes: In registering your student you are committing to the classes you have registered for, until June 2008.  In order for a class to be dropped, parents must contact us before the beginning of the next month.  Otherwise tuition will be charged until the day of notification is given.  You cannot drop a class from the current month we are in.  You will need to pay for that month and drop the class at beginning of the next month.   If you add a class in the middle of the month you need to pay the single class rate  ($15) for the remaining classes of that month.  Credits or refunds will not be given for students dropping classes mid month.  ______

Absences and Make-ups: If a student cannot attend class, make-ups are available with in 30 days. No prorated classes or refunds are available.  ________

Pick-up/Drop off Policy: To ensure the safety of our students, no student should be left waiting longer than 5 minutes after class has ended.  We will have the back door available for pick-up and the front door for drop off.  Parents are solely responsible for their children after their class is over.  _________

Dress Code: Dancers must adhere to a dress code and come fully prepared for class.  Please wear appropriate shoes and proper dance apparel.  Hair must be pulled back for all classes.   Company team members who do not adhere to dress code will not be allowed to participate.  Proper shoes and dance apparel will be required of each student in order to participate.  We have a store set up with these items for sale.

Dance Clothing

Ballet: Pink ballet slippers are required, along with a black leotard and either black or pink tights.  Skirts are optional.

Jazz:  Gore boots are required.  Attire should consist of form fitting clothing such as jazz pants or biker shorts and a form fitting tank top.

Tot and Combo Classes Pink ballet shoes, black tap shoes where applicable, any type of dance attire.  No street shoes.  No tu tu’s please, they are a distraction.

Pre-teen Combo Classes Black gore boots/black tap shoes (where applicable) black leotard and pink ballet tights. 

Hip Hop: Non-scuffing athletic shoes are required.  Any athletic, tight fitting clothing preferred.

Tap: tap shoes are required, jazz pants or shorts and a tank shirt.

Modern/Lyrical Leotard or form fitting tank top and jazz pants. Bare feet preferred.

Cheer Non-scuffing tennis shoes, shorts or dance attire. Please make sure your name is on everything!  Dancers should be clean and neat with hair always pulled back.  

Please make sure your name is on everything! Dancers should be clean and neat with hair always pulled back.

Assumption of Responsibility:  Dancing like any other sport could potentially cause injury.  Please be aware of the risks involved in participating in related activities.  I understand the above risk and assume responsibility for the safety of my child, understanding and accepting the risks involved with dance training.  I hereby waive all claims against and release the owners, principals, teachers and employees of Axis Dance Center from injury or loss incurred.  I agree that these activities are taken at my own risk and I accept this responsibility. _________

Terms and Conditions for Non Payment Customer agrees to pay a finance charge of one and one-half (1 1/2%) per month on all amounts due and owing to Axis Dance Center.

Attorney Fees and Costs: If any legal action is necessary to enforce the terms of this agreement, or if it is necessary to employ the services of an attorney to enforce the terms of this agreement, the party in default or in breach of contract agrees to pay the other party’s reasonable attorney’s fees and all court costs in addition to any other relief to which it may be entitled of customer fails to pay any amounts owing hereunder when due, or otherwise breaches any terms of this agreement.  Customer agrees to pay up to a 40% collection expense incurred by Axis Dance Center in attempting to collect such amounts from customer, in addition to the aforementioned attorney’s fees and costs.

Signature___________________________________            Date_____________________

How did you hear about us?

Drive by_____ Mailed flyer_____  Advertisement______  Phone book ______Friend_______ 

Other please explain  ____________________________________________________

Thank You!